Education Program Evaluation

Tourette Syndrome National Education and Outreach Program

Att C11 Edu Prog Eval Form

Education Program Evaluation

OMB: 0920-0901

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Tourette Syndrome Association Education Program Evaluation

Form Approved

OMB No. 0920-XXXX

Exp. Date XX/XX/20XX


Tourette Syndrome and Associated Disorders in the School

Speaker

Date

Location


Learning Objectives. Participants will be able:

  1. List the criteria for the diagnosis of Tourette Syndrome

  2. Identify the most common disorders associated with TS

  3. Assess the impact of these disorders on classroom performance

  4. Identify specific classroom strategies and techniques for working with children who have TS.



1. Please indicate your PROFESSION: Teacher____ TA/Aide____ SPED Teacher ____ School Nurse____


School Psychologist____ Guidance Counselor____ Social Worker____ O.T.____ SLP____


SPED Director/Administrator_____ Principal/Superintendent____ Other________________(Please Specify)


2. Do you have experience working with clients/students who have TS or tic disorders? Yes___ No___


3. Please rate your knowledge before and after participating in this program

Knowledge BEFORE program

None Some A lot

Self-rating of your knowledge related to:

Knowledge AFTER program

None Some A lot

1

2

3

Recognition of TS symptoms

1

2

3

1

2

3

Recognition of symptoms of co-occurring conditions

1

2

3

1

2

3

Impact of symptoms on classroom performance

1

2

3

1

2

3

Strategies for working with students with TS

1

2

3

1

2

3

Communicating with students and families

1

2

3


4. How much of this content was new to you? Almost all____ 75%____ 50%____ 25%____ Almost None____


Please rate the following statements using a 1-4 scale, where 1 indicates strongly disagree and 4 indicates strongly agree


Strongly disagree

Disagree

Agree

Strongly agree

N/A

5. My skills in working with students who have TS will be improved as a result of this program

1

2

3

4


6. I can assess the impact of these disorders on classroom performance

1

2

3

4


7. I can identify specific classroom strategies and techniques for working with students who have TS

1

2

3

4


8. If given an opportunity, I can apply the knowledge gained as a result of this program

1

2

3

4


9. I intend to use my knowledge to identify students with TS in my school

1

2

3

4


10. I intend to implement educational supports and adaptations for children with TS, where appropriate

1

2

3

4


11. The presenter communicated the content effectively

1

2

3

4



Please describe any changes to your skills, strategy and/or practice:




Suggestions to improve this program: ________________________________________________________________________________





Public reporting burden of this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D- 74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).


File Typeapplication/msword
File TitleTourette Syndrome Association Education Program Evaluation
AuthorPatricia Finnerty
Last Modified Bybhv6
File Modified2011-04-13
File Created2011-04-12

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